Oral Health Status and Salivary Properties Among Children Before and After Tonsillectomy
,
Abstract
Objectives: Enlarged adenoids can lead to obstruction of the nasopharyngeal airway and subsequent oral respiration. Oral breathing can cause dry mouth, dehydration in gingival tissue, and resistance to plaque accumulation. This study aimed to evaluate the impact of tonsillectomy on oral health status, salivary pH and flow rate, and common complications caused by tonsillar hypertrophy in children.
Materials and Methods: An analytical before-and-after study was conducted on 60 children aged 5-12 years who required tonsillectomy. We gathered data through a questionnaire and collected unstimulated saliva using the spitting method for five minutes. Salivary pH was measured by a pH meter and its volume was determined with a calibrated test tube. The plaque index, bleeding index and modified gingival index were determined using a disclosing tablet, Williams’ probe and observational examination, respectively. All measurements were repeated one month after tonsillectomy. Paired t-test was used for data analysis.
Results: We found a significant increase in mean pH and salivary flow rate after tonsillectomy and observed a decrease in oral health indices among the children one month after surgery. Over half of the children who reported complications such as dry mouth, itchy nose and throat, snoring, night sweats, and sleep disturbances experienced complete recovery after tonsillectomy.
Conclusion: Based on the results obtained in the present study, children with enlarged adenoids showed significant improvements in salivary pH, salivary flow rate, and oral health indices, one month after tonsillectomy.
1. Toodeh-Zaeim MH, Ravanmehr H. A survey on dentofacia! cephalometric measurements in mouth breathing patients with nasopharyngeal obstruction. J Dent Med. 2005 Jan 10;17(4):12-8.
2. Valera FC, Trawitzki LV, Anselmo-Lima WT. Myofunctional evaluation after surgery for tonsils hypertrophy and its correlation to breathing pattern: a 2-year-follow up. Int J Pediatr Otorhinolaryngol. 2006 Feb;70(2):221-5.
3. İnönü-Sakallı N, Sakallı C, Tosun Ö, Akşit-Bıçak D. Comparative Evaluation of the Effects of Adenotonsillar Hypertrophy on Oral Health in Children. Biomed Res Int. 2021 Apr 2;2021:5550267.
4. Choi JE, Waddell JN, Lyons KM, Kieser JA. Intraoral pH and temperature during sleep with and without mouth breathing. J Oral Rehabil. 2016 May;43(5):356-63.
5. Al-Awadi RN, Al-Casey M. Oral health status, salivary physical properties and salivary mutans streptococci among a group of mouth breathing patients in comparison to nose breathing. J Baghdad Coll Dent. 2013;25:152–9.
6. Abrishami M R, Akbarzadeh-Bagheban A, Ansari G, Naseri M. Correlation between periodontal diseases and mouth breathing. J Iran Dent Assoc 2008; 20 (2) :100-104
7. Hegde RJ, Thakkar JB. Comparative evaluation of the effects of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and xylitol-containing chewing gum on salivary flow rate, pH and buffering capacity in children: An in vivo study. J Indian Soc Pedod Prev Dent. 2017 Oct-Dec;35(4):332-337.
8. Sedky NA. Assessment of oral and dental health status in children with cerebral palsy: An exploratory study. Int J Health Sci (Qassim). 2018 Jan-Feb;12(1):4-14.
9. Valera FC, Travitzki LV, Mattar SE, Matsumoto MA, Elias AM, Anselmo-Lima WT. Muscular, functional and orthodontic changes in pre school children with enlarged adenoids and tonsils. Int J Pediatr Otorhinolaryngol. 2003 Jul;67(7):761-70.
10. Watanabe M, Sano H, Tomita K, Yamasaki A, Kurai J, Hasegawa Y, et al. A nocturnal decline of salivary pH associated with airway hyperresponsiveness in asthma. J Med Invest. 2010 Aug;57(3-4):260-9.
11. Fathima R, Shenoy R, Jodalli PS, Sonde L, Mohammed IP. Evaluation of Salivary Parameters and Oral Health Status Among Asthmatic and Nonasthmatic Adult Patients Visiting a Tertiary Care Hospital. Cureus. 2019 Oct 21;11(10):e5957.
12. Weiler RM, Fisberg M, Barroso AS, Nicolau J, Simi R, Siqueira WL Jr. A study of the influence of mouth-breathing in some parameters of unstimulated and stimulated whole saliva of adolescents. Int J Pediatr Otorhinolaryngol. 2006 May;70(5):799-805.
13. Glick M. William M. Burket’s Oral Medicine. 12th ed. Shelton, Connecticut, People's Medical Publishing House—USA, 2015.
14. Proffit WR, Fields HW, Sarver DM, Ackerman JL. Contemporary Orthodontics. St. Louis, MO, Mosby, 2000.
15. Trask GM, Shapiro GG, Shapiro PA. The effects of perennial allergic rhinitis on dental and skeletal development: a comparison of sibling pairs. Am J Orthod Dentofacial Orthop. 1987 Oct;92(4):286-93.
16. Cohen MM Sr. Stomatologic alterations in childhood, part II. ASDC J Dent Child. 1977 Jul-Aug;44(4):327-35 cont.
17. Wagaiyu EG, Ashley FP. Mouthbreathing, lip seal and upper lip coverage and their relationship with gingival inflammation in 11-14 year-old schoolchildren. J Clin Periodontol. 1991 Oct;18(9):698-702.
18. Gulati MS, Grewal N, Kaur A. A comparative study of effects of mouth breathing and normal breathing on gingival health in children. J Indian Soc Pedod Prev Dent. 1998 Sep;16(3):72-83.
19. Sharma RK, Bhatia A, Tewari S, Narula SC. Distribution of gingival inflammation in mouth breathing patients: an observational pilot study. J. Dent. Indones. 2016;23(2):28-32.
20. Piva F, Moraes JK, Vieira VR, Silva AE, Hendges RM, Sari GT. Evaluation of the association between indicators of oral health and sociodemographic variables in children with orofacial clinical signs of chronic mouth breathing. Audiol Commun Res. 2014;19:236-42.
21. Nascimento Filho E, Mayer MP, Pontes P, Pignatari AC, Weckx LL. Caries prevalence, levels of mutans streptococci, and gingival and plaque indices in 3.0- to 5.0-year-old mouth breathing children. Caries Res. 2004 Nov-Dec;38(6):572-5.
22. Ingram DG, Ruiz AG, Gao D, Friedman NR. Success of Tonsillectomy for Obstructive Sleep Apnea in Children With Down Syndrome. J Clin Sleep Med. 2017 Aug 15;13(8):975-980.
23. Nuyens MR, Vella S, Bassetti C, Caversaccio M, Häusler R. Objektiver Nutzen der Adeno-Tonsillektomie beim Kind. Eine prospektive Studie über Angina-Inzidenz, Schnarchen, Pulsoximetrien und Polysomnographien sowie über die allgemeine Entwicklung vor und nach Adeno-Tonsillektomie [Objective value of adenotonsillectomy in the child. A prospective study of incidence of tonsillitis, snoring, pulse oximetry and polysomnography and general development before and after adenotonsillectomy]. Praxis (Bern 1994). 1999 May 12;88(20):893-9. German.
24. Kasiri AM, Nasiri E, Esfahahni M. The effect of upper airway obstructive surgery on respiratory symtoms and Spo2. J Mazandaran Univ Med Sci 2008;18(65):82-86
25. So HK, Li AM, Au CT, Zhang J, Lau J, Fok TF, Wing YK. Night sweats in children: prevalence and associated factors. Arch Dis Child. 2012 May;97(5):470-3. doi: 10.1136/adc.2010.199638. Epub 2011 Mar 22.
26. Jalilolghadr S, Hashemi S, Javadi M, Esmailzadehha N, Jahanihashemi H, Afaghi A. Sleep habits of Iranian pre-school children in an urban area: Late sleeping and sleep debt in children. Sleep Biol Rhythms. 2012;10(2):154–156.
27. American Thoracic Society. Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med. 1996 Feb;153(2):866-78.
28. Kryger MH, Roth T, Dement WC. Principles and Practice of Sleep Medicine. 5th ed. Philadelphia PA: Saunders/Elsevier; 2011.
29. Brooks LJ. Obstructive sleep apnea syndrome in infants and children: clinical features and pathophysiology. In: Sheldon SH, Ferber R, Kryger MH (eds) Principles and practice of pediatric sleep medicine. Elsevier Saunders, Philadelphia, 223–229
30. Peled N, Shitrit D, Bendayan D, Peled E, Kramer MR. Association of elevated levels of vascular endothelial growth factor in obstructive sleep apnea syndrome with patient age rather than with obstructive sleep apnea syndrome severity. Respiration. 2007;74(1):50-5.
31. Ray RM, Bower CM. Pediatric obstructive sleep apnea: the year in review. Curr Opin Otolaryngol Head Neck Surg. 2005 Dec;13(6):360-5.
32. Lock C, Wilson J, Steen N, Eccles M, Mason H, Carrie S, et al. Bond J. North of England and Scotland Study of Tonsillectomy and Adeno-tonsillectomy in Children(NESSTAC): a pragmatic randomised controlled trial with a parallel non-randomised preference study. Health Technol Assess. 2010 Mar;14(13):1-164, iii-iv.
33. Senska G, Atay H, Pütter C, Dost P. Long-Term Results from Tonsillectomy in Adults. Dtsch Arztebl Int. 2015 Dec 11;112(50):849-55.
34. Al-Abbasi AM. Tonsillectomy for the treatment of halitosis. Niger J Med. 2009 Jul-Sep;18(3):295-8.
2. Valera FC, Trawitzki LV, Anselmo-Lima WT. Myofunctional evaluation after surgery for tonsils hypertrophy and its correlation to breathing pattern: a 2-year-follow up. Int J Pediatr Otorhinolaryngol. 2006 Feb;70(2):221-5.
3. İnönü-Sakallı N, Sakallı C, Tosun Ö, Akşit-Bıçak D. Comparative Evaluation of the Effects of Adenotonsillar Hypertrophy on Oral Health in Children. Biomed Res Int. 2021 Apr 2;2021:5550267.
4. Choi JE, Waddell JN, Lyons KM, Kieser JA. Intraoral pH and temperature during sleep with and without mouth breathing. J Oral Rehabil. 2016 May;43(5):356-63.
5. Al-Awadi RN, Al-Casey M. Oral health status, salivary physical properties and salivary mutans streptococci among a group of mouth breathing patients in comparison to nose breathing. J Baghdad Coll Dent. 2013;25:152–9.
6. Abrishami M R, Akbarzadeh-Bagheban A, Ansari G, Naseri M. Correlation between periodontal diseases and mouth breathing. J Iran Dent Assoc 2008; 20 (2) :100-104
7. Hegde RJ, Thakkar JB. Comparative evaluation of the effects of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and xylitol-containing chewing gum on salivary flow rate, pH and buffering capacity in children: An in vivo study. J Indian Soc Pedod Prev Dent. 2017 Oct-Dec;35(4):332-337.
8. Sedky NA. Assessment of oral and dental health status in children with cerebral palsy: An exploratory study. Int J Health Sci (Qassim). 2018 Jan-Feb;12(1):4-14.
9. Valera FC, Travitzki LV, Mattar SE, Matsumoto MA, Elias AM, Anselmo-Lima WT. Muscular, functional and orthodontic changes in pre school children with enlarged adenoids and tonsils. Int J Pediatr Otorhinolaryngol. 2003 Jul;67(7):761-70.
10. Watanabe M, Sano H, Tomita K, Yamasaki A, Kurai J, Hasegawa Y, et al. A nocturnal decline of salivary pH associated with airway hyperresponsiveness in asthma. J Med Invest. 2010 Aug;57(3-4):260-9.
11. Fathima R, Shenoy R, Jodalli PS, Sonde L, Mohammed IP. Evaluation of Salivary Parameters and Oral Health Status Among Asthmatic and Nonasthmatic Adult Patients Visiting a Tertiary Care Hospital. Cureus. 2019 Oct 21;11(10):e5957.
12. Weiler RM, Fisberg M, Barroso AS, Nicolau J, Simi R, Siqueira WL Jr. A study of the influence of mouth-breathing in some parameters of unstimulated and stimulated whole saliva of adolescents. Int J Pediatr Otorhinolaryngol. 2006 May;70(5):799-805.
13. Glick M. William M. Burket’s Oral Medicine. 12th ed. Shelton, Connecticut, People's Medical Publishing House—USA, 2015.
14. Proffit WR, Fields HW, Sarver DM, Ackerman JL. Contemporary Orthodontics. St. Louis, MO, Mosby, 2000.
15. Trask GM, Shapiro GG, Shapiro PA. The effects of perennial allergic rhinitis on dental and skeletal development: a comparison of sibling pairs. Am J Orthod Dentofacial Orthop. 1987 Oct;92(4):286-93.
16. Cohen MM Sr. Stomatologic alterations in childhood, part II. ASDC J Dent Child. 1977 Jul-Aug;44(4):327-35 cont.
17. Wagaiyu EG, Ashley FP. Mouthbreathing, lip seal and upper lip coverage and their relationship with gingival inflammation in 11-14 year-old schoolchildren. J Clin Periodontol. 1991 Oct;18(9):698-702.
18. Gulati MS, Grewal N, Kaur A. A comparative study of effects of mouth breathing and normal breathing on gingival health in children. J Indian Soc Pedod Prev Dent. 1998 Sep;16(3):72-83.
19. Sharma RK, Bhatia A, Tewari S, Narula SC. Distribution of gingival inflammation in mouth breathing patients: an observational pilot study. J. Dent. Indones. 2016;23(2):28-32.
20. Piva F, Moraes JK, Vieira VR, Silva AE, Hendges RM, Sari GT. Evaluation of the association between indicators of oral health and sociodemographic variables in children with orofacial clinical signs of chronic mouth breathing. Audiol Commun Res. 2014;19:236-42.
21. Nascimento Filho E, Mayer MP, Pontes P, Pignatari AC, Weckx LL. Caries prevalence, levels of mutans streptococci, and gingival and plaque indices in 3.0- to 5.0-year-old mouth breathing children. Caries Res. 2004 Nov-Dec;38(6):572-5.
22. Ingram DG, Ruiz AG, Gao D, Friedman NR. Success of Tonsillectomy for Obstructive Sleep Apnea in Children With Down Syndrome. J Clin Sleep Med. 2017 Aug 15;13(8):975-980.
23. Nuyens MR, Vella S, Bassetti C, Caversaccio M, Häusler R. Objektiver Nutzen der Adeno-Tonsillektomie beim Kind. Eine prospektive Studie über Angina-Inzidenz, Schnarchen, Pulsoximetrien und Polysomnographien sowie über die allgemeine Entwicklung vor und nach Adeno-Tonsillektomie [Objective value of adenotonsillectomy in the child. A prospective study of incidence of tonsillitis, snoring, pulse oximetry and polysomnography and general development before and after adenotonsillectomy]. Praxis (Bern 1994). 1999 May 12;88(20):893-9. German.
24. Kasiri AM, Nasiri E, Esfahahni M. The effect of upper airway obstructive surgery on respiratory symtoms and Spo2. J Mazandaran Univ Med Sci 2008;18(65):82-86
25. So HK, Li AM, Au CT, Zhang J, Lau J, Fok TF, Wing YK. Night sweats in children: prevalence and associated factors. Arch Dis Child. 2012 May;97(5):470-3. doi: 10.1136/adc.2010.199638. Epub 2011 Mar 22.
26. Jalilolghadr S, Hashemi S, Javadi M, Esmailzadehha N, Jahanihashemi H, Afaghi A. Sleep habits of Iranian pre-school children in an urban area: Late sleeping and sleep debt in children. Sleep Biol Rhythms. 2012;10(2):154–156.
27. American Thoracic Society. Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med. 1996 Feb;153(2):866-78.
28. Kryger MH, Roth T, Dement WC. Principles and Practice of Sleep Medicine. 5th ed. Philadelphia PA: Saunders/Elsevier; 2011.
29. Brooks LJ. Obstructive sleep apnea syndrome in infants and children: clinical features and pathophysiology. In: Sheldon SH, Ferber R, Kryger MH (eds) Principles and practice of pediatric sleep medicine. Elsevier Saunders, Philadelphia, 223–229
30. Peled N, Shitrit D, Bendayan D, Peled E, Kramer MR. Association of elevated levels of vascular endothelial growth factor in obstructive sleep apnea syndrome with patient age rather than with obstructive sleep apnea syndrome severity. Respiration. 2007;74(1):50-5.
31. Ray RM, Bower CM. Pediatric obstructive sleep apnea: the year in review. Curr Opin Otolaryngol Head Neck Surg. 2005 Dec;13(6):360-5.
32. Lock C, Wilson J, Steen N, Eccles M, Mason H, Carrie S, et al. Bond J. North of England and Scotland Study of Tonsillectomy and Adeno-tonsillectomy in Children(NESSTAC): a pragmatic randomised controlled trial with a parallel non-randomised preference study. Health Technol Assess. 2010 Mar;14(13):1-164, iii-iv.
33. Senska G, Atay H, Pütter C, Dost P. Long-Term Results from Tonsillectomy in Adults. Dtsch Arztebl Int. 2015 Dec 11;112(50):849-55.
34. Al-Abbasi AM. Tonsillectomy for the treatment of halitosis. Niger J Med. 2009 Jul-Sep;18(3):295-8.
| Issue | Vol 20 (Continuously Published Article-Based) | |
| Section | Original Article | |
| DOI | https://doi.org/10.18502/fid.v20i24.13168 | |
| Keywords | ||
| Saliva Oral Health Tonsillectomy Airway Obstruction | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Ghafourifard R, Rashidi Maybodi F, Mousavi SA, Pourmirjafari A. Oral Health Status and Salivary Properties Among Children Before and After Tonsillectomy. Front Dent. 2023;20.
